Alex Michael Peterson, PHARM. D

Primary specialty

PharmacistTaxonomy code 183500000X

License

17637 Issued in NV

Practice address

6720 NE 84TH St
Vancouver, WA 98665-2016

Phone

(360) 828-2289

NPI assigned

Mar 13, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331596800000",
    "number": "1427323146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13717 NW 2ND AVE APT 64",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986851901",
            "telephone_number": "702-217-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6720 NE 84TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986652016",
            "telephone_number": "360-828-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ALEX",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "PHARM. D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-13",
        "last_updated": "2012-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NV",
            "license": "17637",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "18355",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH 60196181",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OR",
            "license": "12862",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karrie Janae Petersen, MS, CCC- SLP
• Mari Petersen
• Markell Petersen, SUDP
• Tyler Daniel Petersen, D.O.
• Zoe Peterson-Lipetz
• Andrew Steve Peterson
• Angel Peterson
• Anna Christine Peterson, MA, LMHC, NCC
• Astrid Elaine Peterson, M.A.
• Bradley Lewis Peterson, LMHC

• Pharmacist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.